Investigating the antigenic ligands for autoreactive T cells has been a high priority research goal for T1D because identification of peptide targets will lead to a better understanding of how this autoimmune disease develops and how it might be regulated. Insulin has long been considered to be the most important beta cell autoantigen in type 1 diabetes (T1D), but we recently discovered that two other secretory granule proteins, chromogranin A (ChgA) and islet amyloid polypeptide (IAPP), are also the source of antigenic peptides for autoreactive CD4 T cells. The goals of the first five-year period of this project were focused on identification of antigens for a panel of pathogenic CD4 T cell clones, whether post-translational modification (PTM) was involved in peptide antigenicity, and whether antigenic peptides could be used in strategies to induce antigen-specific tolerance. Our progress with all of these objectives has been significant, but our most notable discovery has been the identification of a novel PTM occurring in islet ?-cells and leading to the formation of hybrid peptides between fragments of insulin and sequences from other secretory granule protein cleavage products. Two of these hybrid insulin peptides (HIPs) have been demonstrated to be highly antigenic for different subsets of T cell clones from our panel, those that are ChgA-reactive and another set that is IAPP-reactive. Our hypothesis in the second five-year period of this project is that the target ligands for autoreactive CD4 T cells are HIPs. Our aims will be to (1) define the role of HIP-reactive CD4 T cells in pathogenesis versus prevention of disease in NOD mice; (2) establish the presence of hybrid peptides in human islet beta cells; and (3) detect and characterize HIP-reactive T cells in human T1D patients and controls. The long-term translational significance of these studies lies in the potential for new reagents that could specifically detect autoreactive T cells as biomarkers of autoimmune diabetes in humans and/or serve as peptides for induction of antigen-specific tolerance.